创伤后急性肾功能衰竭临床多因素分析

Clinical analysis of multiplicity of post-traumatic acute renal failure

目的探讨创伤后急性肾功能衰竭(ARF)的病因、伤情评分、治疗以及预后。方法回顾性分析2000～2005年我院创伤外科收治的创伤后ARF26例,对ARF发生的病因、治疗及预后等多因素进行统计分析。结果创伤后ARF病因以失血性休克和多器官功能不全综合征(MODS)最常见。MODS为ARF的主要死亡原因。与存活组比较,死亡组APACHEⅡ、ATN-ISI评分值高(P<0．01),且多合并MODS(P< 0．01)。透析后血尿素氮、血肌酐和出院血肌酐显著下降(P<0．05)。早期透析病死率低于晚期透析(P< 0．05)。结论失血性休克、MODS为创伤后ARF的主要病因,MODS为主要死亡原因。积极防治休克和MODS有利于防止创伤后ARF的发生。早期防治MODS和肾替代治疗是改善创伤后ARF预后的重要措施。

Objective To investigate the etiology,therapy and outcome of post-traumatic acute renal failure （ARF）. Methods Twenty-six patients with post-traumatic ARF in our department of traumatic surgery from 2000 to 2005 were involved in this study. The etiology, the effect of renal replacement therapy and the prognosis were retrospoctively reviewed. Results The causes of post-traumatic ARF were mainly hemorrhagic shock （ 42% ） and multiple organ dysfunction syndrome （MODS） （38%）. MODS was the predominant cause of death（ 77% ）. The scores of APACHE Ⅱ and ATN-ISI of the death were more than that of the survival（P 〈0.01 ）. The incidence of MODS was also higher in the died group of patients than that found in the survival group（ P 〈0.01 ）. The value of blood urea nitrogen was much less after dialysis than before the first dialysis group（ P 〈 0.01 ）. The values of serum creatinine were much less after dialysis and at discharge than before the first dialysis （ P 〈 0.05 ）. The case fatality of the early dialysis group（ 12.5% ） was lower than that of the late dialysis group（ 66.7% ） （ P 〈 0.05 ）. Condusion Hemorrhagic shock and MODS were the main causes of post - traumatic ARF. The principle cause of death was MODS. In order to reduce the incidence of post-traumatic ARF,we should prevent and treat shock and MODS successfully. Treat MODS actively and give renal replacement therapy as early as possible may improve the outcome of post-traumatic ARF.